ABSTRACT
BACKGROUND: Proximal phalanx fractures are common, with surgical fixation indicated for unstable fractures. Traditionally, closed reduction percutaneous pinning (CRPP) resulted in decreased stiffness and tendon irritation compared to open reduction internal fixation (ORIF). We hypothesized that more recent studies would have more similar outcomes to CRPP. The purpose of this study was to compare CRPP and ORIF in terms of range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and complications. METHODS: Four electronic databases were queried from 2010 to present. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers performed a two-step review process to identify relevant articles. Patient demographics, total active motion (TAM), DASH, and complications were extracted. The methodological quality of each study included was assessed independently. Meta-analysis was performed for comparative trials. RESULTS: Fourteen studies met inclusion criteria including four comparative studies: Thirteen studies included TAM. The weighted average TAM was 228 ± 34° for CRPP and 223 ± 32° for ORIF (P = .07 with 95% confidence interval (CI), -0.5 to 10.5). Seven studies evaluated DASH scores; weighted average was 8.2 ± 8.9 for CRPP and 11.7 ± 6.5 for ORIF (P < .01 with 95% CI, 1.8-5.2). Two studies directly compared CRPP to ORIF, favoring ORIF for both TAM with d = 1.07 and DASH with d = 0.23. Rates of tenolysis or hardware removal were higher for ORIF (P < .01). CONCLUSIONS: New literature suggests more equipoise with regard to treatment of proximal phalanx fracture with CRPP versus ORIF. TYPE OF STUDY/LEVEL OF EVIDENCE: Meta-analysis, Level II.
ABSTRACT
Hip arthroscopy has become an increasingly common procedure with expanding indications over the last several decades. With the increase in number of procedures performed a complication profile has emerged, although there is yet to be a formal classification system for complications. The most cited complications include lateral femoral cutaneous nerve neuropraxia, other sensory deficits, chondral or labral iatrogenic damage, superficial infection and deep vein thrombosis. One complication that has not yet been well documented in the literature is pericapsular scarring/adhesions resulting in decreased hip range of motion and function. If this complication is noted to persist after adequate impingement resection and a rigorous post-operative physical therapy regimen, the senior author has addressed this with a hip manipulation under anesthesia. Therefore, this techniques paper aims to describe pericapsular scarring as a post hip-arthroscopy condition which may cause pain and demonstrate our technique to address this diagnosis through hip manipulation under anesthesia.
ABSTRACT
OBJECTIVES: The importance of the Orthopaedic In-Training Examination (OITE) is well documented. The purpose of this study is to provide an updated analysis of the oncology section compared to the review by Frassica et al. from 2002 to 2006, as a means to provide insight into more focused resident study. DESIGN: This study is a retrospective database review using published OITE exams from years 2013 to 2019. Methods were based off a previous review by Frassica et al. where oncology-related questions were analyzed for underlying diagnosis, benign versus malignant condition, imaging and histology provided, and genes/translocations tested. Questions were classified by category and taxonomy. RESULTS: Oncology-related questions per exam ranged from 19 (7%) to 23 (8.4%) of total questions, which is fewer than years 2002 to 2006. Twenty malignant and 27 benign entities were tested with malignant conditions tested at a higher rate of 1.3:1 versus benign. Eighteen combinations of imaging modalities were provided for analysis versus 11 from 2002 to 2006. With regard to taxonomy, the average number of questions per classification ranged from 2.4 to 5.4. The least common classification tested was treatment modality and the most commonly tested classification was treatment from diagnosis (taxonomy 3). Previously, tumor knowledge (taxonomy 1) was most tested with an average of 8.8 questions per exam. 12 questions were directly related to genes and translocations across all years. CONCLUSIONS: Oncology questions made up a smaller percentage of the OITE exam than previous years, although more conditions were tested using more imaging combinations, necessitating a wider range of knowledge. However, malignant conditions continue to be tested more commonly. There has been a shift toward Taxonomy 3 level questions, indicating a higher level of thought processing required from residents as opposed to recall. Additionally, genes and translocations became more commonly tested throughout the most recent analysis, indicating a focus for future years of study.
